Wastewater Analysis of SARS CoV-2 in Tribal Communities

ABSTRACTThe rapid onset of the COVID-19 pandemic left many across the world unprepared to test, treat, and plan forcoronavirus morbidity and mortality. This was true for Tribal nations, whose sovereign status enabled swift andpreventative measures such as lock-downs and border closures, yet whose culture contributed to additionalunique risk factors. Among those are testing disparities, underlying health factors, and community infrastructure.However, clinical testing doesn't capture the extent of positive cases, and without the collective efforts of thisproject, Tribes will likely not be included in wastewater-based epidemiology (WBE) analysis, which has garneredwide-spread interest due to its ability to generate data in advance of community infectivity. In this project, we willshow that WBE is a non-invasive, culturally appropriate biomonitoring strategy that can be adopted andimplemented by Tribal communities to empower them with a practical, yet technologically advanced healthsurveillance tool. Building upon a rigorous methodology of Tribal consultation and community-based participatoryresearch, assessment of wastewater and community infrastructure, and training of Tribal wastewater operatorsand health administrators on WBE, we will form the WBE Tribal Coordination Center. Tribes will be recruitedthrough the InterTribal Council of Arizona's National Tribal Water and Wastewater Operator Training Programnetwork. We will measure coronavirus in wastewater across U.S. reservations using established RT-qPCRtechniques and a novel protein quantification method, and we will sequence viral RNA extracts to assess SARS-CoV-2 variants in Tribal communities. Risk factors contributing to elevated COVID-19 in Tribal communities willbe quantified with integration of geospatial analysis. Frameworks for risks from numerous environmentally-transmitted pathogens have been developed by our team, setting a foundation to incorporate variability anduncertainty for Tribal settings with qualitative information from Tribes in order to appropriately scope our modelingefforts. Simulation results will help to target resources efficiently for monitoring and public health interventionsby identifying specific sampling locations where it is most likely to detect SARS-CoV-2 given other communityand scientific constraints. Information from the RADx Data Coordination Center will be used to the fullest extentto compare Tribal communities with their non-Tribal counterparts. Through the coronavirus pandemic andbeyond, Tribes will be better informed of their ability to use WBE to measure community health, therebyprotecting community health and building capacity for future applications and research translation.